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Structural racism is hardwired into American public policy and has a deleterious effect on the health status of Black people. Poor Black health outcomes are the manifestation of the lack of equal opportunity and the denial of full citizenship rights dating back to before the passage of the Emancipation Proclamation, and even since the passage of the Civil Rights Act of 1964. Today, the state of Black health in the United States, one of the most affluent countries in the world, is a growing public health concern. In our upcoming book chapter, we identify structural racism as a risk factor for adverse health outcomes and call for racism to be identified as a social determinant of health. No longer is it appropriate to mask racism by making it synonymous with discrimination, an oft inconsequential legal term that serves as a barrier to accessing the rights and freedoms of full citizenship for Black Americans.

While Black people in the United States face a disproportionate burden of illness, injury, death and disease, the death of any child before their first birthday is one of the most troubling and often preventable outcomes. As such, infant mortality rates are often used as a sensitive barometer of the health of a community. In 2017, the Black infant mortality rate of 11.0 (deaths per 1,000 live births) was nearly three times the rate of the White infant mortality rate (4.7) and on par with countries such as Turkey and Libya. In much the same way, Black women are dying in childbirth at an alarming rate. In 2018, Black women died in childbirth at a rate of 37.1 (deaths per 100,000 live births), while White women only experienced a rate of 14.7. These indicators point to deeply troubled systems in the United States. One social. One healthcare. Both underscored by structural racism. 

To be Black in America is to be saddled with a legacy of oppression and subjugation that extends beyond our existence and engulfs a deeply complex chasm that divides American life and the American dream. But not since the Civil War has this nation so openly grappled with manifestations of racism. The killings of George Floyd, Breonna Taylor, Ahmaud Arbery and Rayshard Brooks, and the experience of Christian Cooper in New York City’s Central Park offer a sobering reality of the perils of being Black in America. Social protests around the world are fueled by the seemingly unabated procession of killings by law enforcement officers. These killings are tantamount to human rights violations—abuses to the security of a person by state actors. Law enforcement officers should be peace officers, but that notion has been corrupted by an assault on the civil liberties of Black Americans by “a few bad actors.” 

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